A cornerstone of therapy for patients with acute coronary syndrome is Dual anti–platelet therapy (DAPT). Clopidogrel has been used extensively worldwide for more than a decade; Recently, new anti–platelet agent, Ticagrelor, has been developed and tested clinically, resulting in faster, more potent and consistent anti–platelet action. Ticagrelor is an antiplatelet agent chemically known as a cyclopentyltriazolopyrimidine, with distinguishing properties from that of theinopyridines. Clopidogrel, a second–generation thienopyridine, is now available as a low–cost generic drug, with favourable cost effectiveness ratio. This study aimed to compare the safety, efficacy and cost of Ticagrelor and Clopidogrel, based on all the literatures available for free in Pub med and Medline. Pharmacokinetic and pharmacodynamic properties were compared with the data, collected from Lexicomp drug software. Ticagrelor has advantages over Clopidogrel in terms of its mechanism of action. Ticagrelor acts reversibly and Clopidogrel acts irreversibly. Onset of action was rapid for Ticagrelor when compared to Clopidogrel. With respect to the adverse drug reactions, higher incidences of ADRs were reported with Ticagrelor. The bleeding risk is high for Ticagrelor and newer side effect like dyspnoea was also reported. The cost analysis of both these agents showed that Ticagrelor is almost 12–13 times costlier than Clopidogrel generic in India. If the cost of Ticagrelor was at par or even if, one to two times costlier than Clopidogrel, Introduction in the Indian subcontinent would have been more meaningful, for long term use patients.